Harvard Pilgrim Health Care of NE claim denials in New Hampshire: the federal figures
Harvard Pilgrim Health Care of NE denied 20.9% of in-network claims in New Hampshire — 31,314 claims out of 149,497. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to Harvard Pilgrim Health Care of NE) | 63 | 55.6% |
| External review (independent) | — | — |
What to do if Harvard Pilgrim Health Care of NE denied your claim
- Get the reason in writing. The denial notice must state the specific reason and the plan provision behind it. If it does not, request it — you are entitled to it free of charge.
- File the internal appeal. Generally within 180 days of the denial notice. Harvard Pilgrim Health Care of NE overturned 55.6% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not Harvard Pilgrim Health Care of NE. Generally you have 4 months from the final internal denial. This is the step nearly everyone skips.
- Ask for expedited review if waiting would seriously jeopardise your health. That timeline is days, not months.
Everything you need for your Harvard Pilgrim Health Care of NE appeal: your two deadlines, the argument that fits your denial reason, an evidence checklist, and the external review request. Opens on screen the moment you pay.
Questions
Is Harvard Pilgrim Health Care of NE's denial rate high?
20.9% against a national average of 16% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
Does appealing cost anything?
The internal appeal is free. External review is free under the HHS-administered federal process; where an issuer uses a contracted independent review organization or a state process, any fee is capped at $25.
Can Harvard Pilgrim Health Care of NE ignore the external decision?
No. External review decisions are binding on the plan.